Adding life to our years, not years to our lives

Australia’s latest Intergenerational Report contains some genuinely good news: we are going to live longer. 

By 2066, Treasury projects that life expectancy will reach almost 90 years for women and 86 years for men, helped by better healthcare, healthier lifestyles and medical innovation.  

That’s something worth celebrating for sure. 

But how long we live is only part of the story. What matters just as much is how long we remain healthy. 

And on that measure, we have a problem. 

A 2024 study published in JAMA Network Open compared life expectancy with healthy life expectancy across 183 countries. Australia had a 12.1-year gap between the two – the second-largest ‘sickspan’ in the world. 

A 2026 Lancet Public Health study tells the same story. Australians spend an estimated 13.9 years of their lives in poor health, again the second-longest period in the world after the US. 

High-income countries like ours, where people live longer, tend to have a longer sickspan. That’s partly because modern medicine is often better at keeping people alive than it is at keeping them healthy. 

It’s good news that modern medicine allows us to survive heart attacks and strokes more often , replace worn-out joints and manage illnesses that would once have killed us. Even serious illnesses like cancer and diabetes can often now  be controlled in ways that we could once only wish for. These are remarkable achievements. 

But keeping somebody alive is just part of keeping them healthy. 

 The Australian Institute of Health and Welfare estimates that a girl born in 2024 can expect to live 85.5 years, but only 73.8 of them in full health. For boys, the figures are 81.6 and 71.7 years. Since 2003, the average time Australians spend in ill health has increased – by 1.2 years for men and 1.5 years for women. 

This should change the way we think about an ageing population. Reaching 90 is an achievement. Reaching 90 after spending the previous 15 or 20 years in poor health is less impressive. 

Investing in health not disease 

While Australia relies on increasingly expensive medical technology to keep people alive for longer, we still do too little to stop people becoming sick in the first place. Not only would changing this balance this help give Australians a better quality of life, it would save our healthcare system a lot of money. 

The Intergenerational Report spends a lot of time worrying about what older Australians will cost the budget. This focus is understandable, given that Australia’s ageing population will mean growing demand for the kinds of health services that Treasury expects will push government spending higher. 

But the health of Australia’s older, future population is not fixed. We can change things in the present that will make a big difference in the future. as the old saying goes, an ounce of prevention beats a pound of cure. 

The decisions we make today will determine whether in the decades to come Australia has an abundance of 80-year-olds who are active, independent and healthy, or one where much of that cohort are beset with chronic illnesses that require extensive medical care over many years. . 

That’s why prevention is best seen as an investment rather than an optional extra.  

Australia currently spends about $270 billion per year treating illness. Yet preventative health strategies accounted for just 2.9% of that expenditure – among the lowest in the OECD. 

Australia’s National Preventive Health Strategy aims for Australians to gain another two years of life in full health by 2030, setting a target of lifting public health spending to 5 per cent of government health expenditure. 

We’re currently nowhere near reaching that goal. 

Adding life to our years 

To be clear, preventative health  means much more than telling people to eat better and exercise. 

Yes, governments could make unhealthy products less attractive and healthy choices easier. Measures such as taxes on sugary drinks, restrictions on junk-food advertising, better urban design and stronger action on alcohol and tobacco could all help. 

But some of the most powerful health policies sit outside the health portfolio altogether. 

Education affects health. So does income and income distribution, employment and housing. Poverty and insecure work make makes people sick – Australians on income support are dying at five times the rate of the rest of the population.  

Poor housing makes people sick. The conditions in which children grow up shape their health decades later. These are the social determinants of health that the AIHW explicitly identifies.  

The evidence makes clear that spending money on those things need to be seen as health policy too. 

The Commonwealth Treasury says Australians in 2066 will be among the longest-living people in the world. Hopefully they are right.  

But when the next Intergenerational Report arrives, we’d be wise to pay at least as much attention to healthy life expectancy as life expectancy. 

After all, our $270 billon health spend should add life to our years, not just years to our lives.